1
|
Chang L, Zhou DB, Cao XX. Gamma heavy chain disease: a retrospective analysis of 6 cases. Orphanet J Rare Dis 2023; 18:77. [PMID: 37041608 PMCID: PMC10091613 DOI: 10.1186/s13023-023-02679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/12/2023] [Indexed: 04/13/2023] Open
Affiliation(s)
- Long Chang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China.
| |
Collapse
|
2
|
Deighan WI, Winton VJ, Melani RD, Anderson LC, McGee JP, Schachner LF, Barnidge D, Murray D, Alexander HD, Gibson DS, Deery MJ, McNicholl FP, McLaughlin J, Kelleher NL, Thomas PM. Development of novel methods for non-canonical myeloma protein analysis with an innovative adaptation of immunofixation electrophoresis, native top-down mass spectrometry, and middle-down de novo sequencing. Clin Chem Lab Med 2020; 59:653-661. [PMID: 33079696 DOI: 10.1515/cclm-2020-1072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/07/2020] [Indexed: 12/18/2022]
Abstract
Objectives Multiple myeloma (MM) is a malignant plasma cell neoplasm, requiring the integration of clinical examination, laboratory and radiological investigations for diagnosis. Detection and isotypic identification of the monoclonal protein(s) and measurement of other relevant biomarkers in serum and urine are pivotal analyses. However, occasionally this approach fails to characterize complex protein signatures. Here we describe the development and application of next generation mass spectrometry (MS) techniques, and a novel adaptation of immunofixation, to interrogate non-canonical monoclonal immunoproteins. Methods Immunoprecipitation immunofixation (IP-IFE) was performed on a Sebia Hydrasys Scan2. Middle-down de novo sequencing and native MS were performed with multiple instruments (21T FT-ICR, Q Exactive HF, Orbitrap Fusion Lumos, and Orbitrap Eclipse). Post-acquisition data analysis was performed using Xcalibur Qual Browser, ProSight Lite, and TDValidator. Results We adapted a novel variation of immunofixation electrophoresis (IFE) with an antibody-specific immunosubtraction step, providing insight into the clonal signature of gamma-zone monoclonal immunoglobulin (M-protein) species. We developed and applied advanced mass spectrometric techniques such as middle-down de novo sequencing to attain in-depth characterization of the primary sequence of an M-protein. Quaternary structures of M-proteins were elucidated by native MS, revealing a previously unprecedented non-covalently associated hetero-tetrameric immunoglobulin. Conclusions Next generation proteomic solutions offer great potential for characterizing complex protein structures and may eventually replace current electrophoretic approaches for the identification and quantification of M-proteins. They can also contribute to greater understanding of MM pathogenesis, enabling classification of patients into new subtypes, improved risk stratification and the potential to inform decisions on future personalized treatment modalities.
Collapse
Affiliation(s)
- W Ian Deighan
- Department of Clinical Chemistry, Altnagelvin Area Hospital, Londonderry, UK
| | - Valerie J Winton
- Proteomics Center of Excellence, Northwestern University, Evanston, IL, USA
| | - Rafael D Melani
- Proteomics Center of Excellence, Northwestern University, Evanston, IL, USA
| | - Lissa C Anderson
- Ion Cyclotron Resonance Program, National High Magnetic Field Laboratory, Tallahassee, FL, USA
| | - John P McGee
- Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA
| | - Luis F Schachner
- Department of Chemistry, Northwestern University, Evanston, IL, USA
| | - David Barnidge
- Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David Murray
- Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - H Denis Alexander
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Londonderry, UK
| | - David S Gibson
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Londonderry, UK
| | - Michael J Deery
- Cambridge Centre for Proteomics, University of Cambridge, Cambridge, UK
| | | | - Joseph McLaughlin
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, Londonderry, UK
| | - Neil L Kelleher
- Proteomics Center of Excellence & Departments of Chemistry and Molecular Biology,Northwestern University, Evanston, IL, USA
| | - Paul M Thomas
- Proteomics Center of Excellence & Departments of Chemistry and Molecular Biology,Northwestern University, Evanston, IL, USA
| |
Collapse
|
3
|
Thoren KL, Eveillard M, Chan P, Doddi S, Cho S, Murata K. Identification of gamma heavy chain disease using MALDI-TOF mass spectrometry. Clin Biochem 2019; 77:57-61. [PMID: 31884198 DOI: 10.1016/j.clinbiochem.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
We describe the use of MALDI-TOF mass spectrometry in the analysis of a suspected case of gamma heavy chain disease. The patient had an abnormal serum immunofixation result where a monoclonal gamma heavy chain band was present without a corresponding light chain. Analysis by MALDI-TOF mass spectrometry revealed large peaks in the spectrum following IgG-specific purification. The m/z values of the peaks were outside the expected range for normal heavy chains or light chains. Corresponding peaks were not present in mass spectra of the kappa- or lambda-specific purifications. MALDI-TOF MS confirmed the presence of a truncated heavy chain without associated light chains. This case report demonstrates the value of mass spectrometry in interpreting challenging cases such as the identification of heavy chain disease.
Collapse
Affiliation(s)
- Katie L Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA.
| | - Marion Eveillard
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA
| | - Patrick Chan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA
| | - Sital Doddi
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA
| | - Sun Cho
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA
| | - Kazunori Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 327 E. 64th St., New York, NY 10065, USA
| |
Collapse
|
4
|
Bosman MCJ, Schreurs RHP, Nieuwenhuizen L, Bakkeren DL, Jacobs JFM. Broad Bands Observed in Serum Electrophoresis Should Not Be Taken Lightly. Clin Chem 2019; 65:618-621. [DOI: 10.1373/clinchem.2018.297176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Matthieu C J Bosman
- Laboratory for Clinical Chemistry and Hematology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Rachel H P Schreurs
- Department of Internal Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | | | - Dirk L Bakkeren
- Laboratory for Clinical Chemistry and Hematology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Joannes F M Jacobs
- Department of Laboratory Medicine, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| |
Collapse
|
5
|
Two Cases of γ-Heavy Chain Disease and a Review of the Literature. Case Rep Hematol 2018; 2018:4832619. [PMID: 30186642 PMCID: PMC6109557 DOI: 10.1155/2018/4832619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
Gamma heavy chain disease (γ-HCD) is a rare lymphoproliferative disorder characterised by the production of a truncated immunoglobulin heavy chain. Fewer than 200 cases have been reported in the literature. In some cases, γ-HCD occurs with other lymphoid neoplasms. This study reports clinical, biochemical, haematological, and histological findings in two cases of γ-HCD. We describe newer biochemical diagnostic tools (HevyLite measurement, capillary electrophoresis, and immunotyping) that can aid in the characterisation of γ-HCD. The first case is an 88-year-old woman with γ-HCD. The second case is an 81-year-old woman who developed γ-HCD during treatment for Waldenstrom's macroglobulinemia. In the second patient, histopathology identified a separate clone responsible for the secretion of the gamma heavy chain. Studies on the clonal evolution of the disease may provide insight into therapeutic implications and the genomic complexity of the disease.
Collapse
|
6
|
Robier C, Neubauer M. Gamma heavy chain disease evolving during the progression of chronic lymphocytic leukemia. Clin Chem Lab Med 2018; 56:e154-e156. [PMID: 29315075 DOI: 10.1515/cclm-2017-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Christoph Robier
- Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of God, Graz, Austria.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Manfred Neubauer
- Institute of Laboratory Diagnostics, Hospital of the Brothers of St. John of God, Graz, Austria.,Hematologic Outpatient Clinic, Department of Internal Medicine, Hospital of the Brothers of St. John of God, Graz, Austria
| |
Collapse
|